Question

Concept Map - Renal Insufficiency You are working in the ICU of an acute care hospital and assume the care of Edith Bunker, a 78 year-old woman who is 3 days post inferior wall MI. Mrs. Bunker had been healthy before admission except for a longstanding history of arthritis treated with rofecoxib (Vioxx) 50mgm daily and longstanding hypertension treated with atenolol (Tenormin) On admission to the emergency room the patent had a blood pressure of 210/122 mm Hg, therefore thrombolytics were contraindicated. An IV was started with D5/W at keep open rate and was taken directly to the cardiac catheterization lab for acute PTCA. Her angioplasty was successful, and she has been pain free since her PTCA. You are reviewing her lab work and note the following values: NA 142 K 4.6 CI 100 CO2 26 BUN 60 Creatinine 3.8 158 Glucose

Answer 1

5) abnormalities in laboratory studies -- lab test may fails because ,,, sometime mistake in ordering lab test means right test are not ordered at right time. And problem with accuracy, availability and interpretation of their results.

6) Acute urinary retention causes -- occurs due to obstruction of urethra.

In Males -- benign prostatic enlargement due to BPH,, carcinoma of prostate,, urethral stricture,, prostatic abscess

In Females -- pelvic prolapse,, urethral stricture,, urethral diverticulum,,

7) lab values that changed over 24 years

Na- decreased because of IV use,, gastrointestinal impairment

K increased -- renal failure,, metabolic acidosis

Cl increased -- hypertonic IV,, renal failure,, metabolic acidosis

CO 2 -- decreased -

BUN increased -- renal failure,, increased protein catabolism,, fever, CHF

Creatinine increased -- renal disease,, muscular dystrophy,, dehydration

Glucose decreased -- excess insulin,, pituitary deficiency,, addison disease

8)--significance of urine output -- urine output is a marker of kidney function and also guide fluid resuscitation in ill patient. Urine output decrease signify decrease glomerular filtration rate due to decrease of renal blood flow